Komaba Hirotaka, Tanaka Motoko, Fukagawa Masafumi
Division of Nephrology and Kidney Center, Kobe University School of Medicine, Kobe.
Intern Med. 2008;47(11):989-94. doi: 10.2169/internalmedicine.47.1051. Epub 2008 Jun 2.
Disturbances in mineral and bone metabolism play a critical role in the pathogenesis of cardiovascular complications in patients with chronic kidney disease (CKD). The term "renal osteodystrophy" has recently been replaced with "CKD-mineral and bone disorder (CKD-MBD)", which includes vascular calcification as well as bone abnormalities. Following this paradigm shift, the Japanese Society for Dialysis Therapy released guidelines for the management of secondary hyperparathyroidism in chronic dialysis patients, which prioritized improvement in survival, but not in bone abnormalities. According to these guidelines, parathyroid intervention, such as parathyroidectomy and percutaneous ethanol injection therapy, should be indicated if mineral disorders cannot be managed by pharmacological means. Recently, several novel therapeutic tools, including sevelamer hydrochloride, calcitriol analogs, and cinacalcet hydrochloride have been introduced in the clinical setting in Japan. Harmonizing these therapeutic modalities, we should expect more effective management of CKD-MBD, leading to the improvement of morbidity and mortality in this patient population.
矿物质和骨代谢紊乱在慢性肾脏病（CKD）患者心血管并发症的发病机制中起关键作用。术语“肾性骨营养不良”最近已被“CKD-矿物质和骨异常（CKD-MBD）”所取代，后者包括血管钙化以及骨异常。随着这一范式转变，日本透析治疗学会发布了慢性透析患者继发性甲状旁腺功能亢进管理指南，该指南将提高生存率置于优先地位，而非改善骨异常。根据这些指南，如果药物手段无法控制矿物质紊乱，则应采取甲状旁腺干预措施，如甲状旁腺切除术和经皮乙醇注射治疗。最近，包括盐酸司维拉姆、骨化三醇类似物和盐酸西那卡塞在内的几种新型治疗工具已在日本临床应用。协调这些治疗方式，我们有望更有效地管理CKD-MBD，从而改善该患者群体的发病率和死亡率。
